Monday, March 10, 2008

Canadian health-care history enough to make you puke

“Sometimes there seems such a whack of naked emperors in this country, one hardly knows whose bare butt to point to first. Nowhere is the emperor more glaringly unclothed and are people less inclined to acknowledge his nudity than in the area of health care. Having had to shepherd two aged and infirm parents through emergency wards, rehab centres, doctors' offices, clinics and the like, I have come to realize that the public health-care machine is wearing out.

In a nutshell, socialized medicine was invented at a time when the majority of the population was young, healthy, having lots of kids and paying into a system that had relatively few expensive, high-tech procedures. We have now moved into a time with an ever- increasing population of sick seniors demanding more high-tech procedures and fancy drugs. Meanwhile, all those babies they forewent or aborted aren't available to pay the premiums.

The fixes are practically as obvious as the symptoms: more accountability; user fees; competition among providers; the privatization of facilities and services to stop those ever- grasping health-care unions in their tracks. Crusty old Don Mazankowski, in his report for the Alberta government released in January, offered a fairly good blueprint for rebuilding the machine. He suggested things such as medical savings accounts, private providers and a reduction in the number of high-priced registered nurses.

Yet doing the necessaries to health care has, in Canadian political circles, become tantamount to clubbing and skinning live baby seals. This is thanks in large part to the extreme and prolonged cunning of the most successful and powerful of all our buck-naked emperors, Prime Minister Jean Chretien.

Through his three successful elections, Mr. Chretien has draped himself in the invisible magnificence of the Canada Health Act. He has defended the sanctity of Canada's medicare system, demonized the American alternative and established a code of official nudism by which every other politician feels bound. One by one, they have all succumbed. Preston Manning once talked sensibly about fixing the broken medical system. But when Mr. Chretien started to brand Reform as the despoiler of medicare, Presto quickly recanted and got naked. Ditto Stock Day, Mike Harris and, eventually, Ralph Klein.

So what can we expect from that redoubtable redistributor of income, Roy Romanow?The former socialist premier of Saskatchewan is a longtime buddy of the prime minister. Back in 1981, when Mr. Chretien was the federal constitutional affairs minister and Mr. Romanow the dashing Saskatchewan attorney general, they toured the country together selling Pierre Trudeau's Constitution. They were nicknamed Uke and Tuque.

After he stepped down as premier in 2001, Mr. Romanow became the chairman of Mr. Chretien's $15-million Commission on the Future of Health Care in Canada. He was to be paid $750 a day and would -- supposedly -- be allowed to reach his own conclusions and make his own recommendations in the report that is due in November.

At first, Uke made a lot of brave noises about having an open mind, being his own man, considering all the alternatives, including even, possibly, user fees or private providers. But word reached my cave in June that officials from the Prime Minister's Office were reportedly becoming more involved in the process. These PMO boffins, I was told, had made it clear to poor Uke that he would be expected to follow the company line.

Health care, goes this line, is intrinsically sound. Best system in the world. Of course, it will need a bit more cash. Taxes will go up a bit, but Canadians are willing to pay a bit more to insure the continuance of excellence. Polls will be engineered to prove this.

Mr. Romanow was urged to try to release the report a bit earlier than November. Such naked vote-buying, tried and tested during three election campaigns could, it was felt, be just what was needed to send that bounder Paul Martin packing once and for all.

Thus by late June, Uke called a special news conference to draw attention to a survey conducted by the Canadian Policy Research Networks, an organization funded by the Liberal government, that purported to show that most Canadians are happy to pay higher taxes to support health care. He also said he was "not convinced" there was a fiscal crisis in health care.A couple of weeks later, another report was released that suggested some of Mr. Mazankowski's suggested reforms contravened the Canadian Health Act.

And so the striptease begins. It won't be a pretty sight, but it's one of which we, as Canadians, should be extremely proud.

You know the schtick.”

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Yes, we know the schtick…pretending that socialized medicare is the same as actual health-care. Pretending that sanctimonius Liberals are the only people righteous enough to Provide Health Care To The Masses… Yeah, right.

It’s interesting to go back only a scant six years ago and see Canada's health-care debate as it was at the time… Chretien’s Liberals bamboozled Canada completely.

All this was before Chaoulli appeared in Quebec, before Pierre Pettigrew was castigated by his own Liberals for daring to suggest the provinces have some more leeway in health care delivery, before Prime Minister Paul Martin’s bombastic, soon to be forgotten, flash in the pan health care 'solution for a generation'.

The Romanow report was essentially forgotten; the Liberals never really were going to do anything about it anyway. As Dolphin described, Chretien co-opted Romanow as his front end PR guy to give Chretien legitimacy. What the 'Tuque' did to the 'Uke' was enough to make anyone puke.

Romanow at first was claiming to be open, to be considering all the options, including different options such as possible user fees and private provider options. Those ‘brave noises’ coming from Romanow were quickly made to toe Jean Chretien's line. And even more quickly, the MORE REALISTIC Mazankowski Report’s health care recommendations were demonized, discredited and disappeared… just like Romanow’s were, a little bit later.

Chretien’s Liberals smeared Mazankowski’s report with suggestions it might contravene the Canada Health Act. Now there’s a beauty for you – the Canada Health Act was a piñata for Chretien’s Liberals! Mazankowski’s health care reform proposals were always on the right track – that’s why they were ignored. Canadians were forced to watch and pretend to believe Jean Chretien’s smug, partisan Liberal health-care duplicity for years.

“In his Sept. 9 column, "Where's the debate on Medicare?" John Turley-Ewart poignantly expressed the horrible experience endured by his ailing mother as she waited for care that came too late. He criticized all political parties for neglecting to offer bold solutions to fix our health care system. However, I can assure the author that within the Liberal party there is a dynamic debate concerning this, the most important issue affecting Canadians. The solutions offered in our debates are varied, and mirror those echoed by Canadians from coast to coast. But while this debate is essential, it must not hinder action.

As a physician, I became a Member of Parliament to save our public health care system because I saw too many patients like Mrs. Turley, who needlessly suffered in silence, or died because they got access to a waiting list, not access to care. Our ageing population and increasingly expensive medical technologies are resulting in an 8% per year increase in costs, while revenues are rising at 3% per year. This has resulted in an ever widening gap between supply and demand. Most provinces spend roughly 40% of their revenues on health care. By 2017, this one item will consume over 70% of their budgets, an utterly unsustainable burden for any province.

Today, this gap between supply and demand manifests itself in longer waiting lines, bed closures, the withdrawal of funding for services ("delisting") and our inability to hire health care professionals. In this environment, it is the poor and middle class who get hurt, not the rich, for they can always go to the United States to receive their care. The facts are stark, frightening and irrefutable. For all patients, the rhetoric must be buried and solutions implemented based on these facts.

So what are some of those solutions?

1. Modernize the Canada Health Act (CHA) to allow the private sector to support the public sector by taking some of the demand out of the public system without removing resources. (Allow people to purchase services with their own money separate from the public system, and forbid public monies from co-funding procedures.)

Many of the principles in the Canada Health Act are excellent, but the single-payer (read: government) requirement is a major obstacle to enabling achievement of the other four principles (comprehensiveness, universality, portability and accessibility). In fact, anyone who works in health care knows that all five principles of the CHA are broken in every province, every day, because of the increasing gap between supply and demand. A modernized Canada Health Act should ensure timely access to quality care for all Canadians regardless of their income, and that this benefit is portable across the land.

2. We need a national human-resource strategy for health care personnel; doctors, nurses, technicians, etc. As we get older, so to do our health care workers, which is causing a crisis in medical manpower, and a deficit that cannot be rectified quickly, or easily.

3. We need a national strategy on mental health. According to the World Health Organization, depression will become the second leading cause of illness in the world. Furthermore, with our ageing population, we will see a massive increase in the incidence of dementias, a situation we are completely unprepared for.

4. We need a Centre for Best Health Care Practices. It is surprising how poor we are at accumulating and disseminating information about best practices. This centre could be within the existing framework of the Canadian Institute for Health Research or the Canadian Institute for Heath Information.

These suggestions would dramatically improve access to health care in Canada. If the feds and the provinces (which are the managers of health care) implement these solutions, we will have a public health care system that will ensure that, regardless of your income or where you fall ill, you will have access to quality care in a timely fashion, not just entry into a waiting list. In doing so, tragedies such as that which befell Mrs. Turley will thankfully become a thing of the past.”
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Conservative Don Mazankowsi was on the right track and later, Liberal Keith Martin was on the right track. But, their ideas were ignored, buried away and gone as if they'd never been uttered.

It is sickening to see how much time Canadians have wasted pursuing socialism, when we should have been busy pursuing health-care.
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